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Surg Radiol Anat. 2013 Sep;35(7):579-84. doi: 10.1007/s00276-013-1108-2. Epub 2013 Mar 21.

The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults.

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  • 1Department of Anesthesiology, KSU School of Medicine, Kahramanmaras, Turkey.

Abstract

BACKGROUND:

Caudal epidural block (CEB) is a reliable and effective technique commonly used in pain practice. Having accurate knowledge of sacral anatomy and its anatomical variations is very important for avoiding complications, especially as may occur during dural puncture. This study was undertaken to delineate the anatomical features of the sacrococcygeal region relevant to dural sac (DS) puncture.

METHODS:

We reviewed magnetic resonance (MRI) images of 1,000 adult patients to determine of the level of termination of the DS, the distance between the upper margin of the sacrococcygeal membrane and the DS, and the presence of incidental dural cystic lesions. Each sacral vertebra was divided into three equal portions (upper, middle, and lower thirds), was defined as a separate region.

RESULTS:

The level (26.7% of all patients) of termination of the DS was most commonly the upper one-third of S2. The DS terminated below the 3rd sacral vertebra in 0.1% of all patients. No posterior sacral meningocele was seen, but 13 (1.3% of all patients) had a sacral Tarlov cyst. In three of 13 patients (23%), the Tarlov cysts terminated below 3rd sacral vertebra level (0.3% of all patients).

CONCLUSION:

Knowledge of the level of termination of the DS, the distance between the upper margin of the sacrococcygeal membrane and the DS, and the presence of Tarlov cysts on MRI images of before CEB is very important and might decrease the risk of dural puncture.

PMID:
23515954
[PubMed - indexed for MEDLINE]
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